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CP3 SURGERY > GEN SURG part 1 > Flashcards

GEN SURG part 1 Flashcards

1
Q

Def clean operative procedure

A

Procedure doesn’t enter a colonised viscus, or lumen in the body

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2
Q

What is surgical site infection due to in a clean operative procedure?

A

Contaminants from enviro/surgeon

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3
Q

Def potentially-contaminated operative procedure?

A

Operative procedure enters into a colonised viscus or body cavity under elective/controlled circumstances

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4
Q

What is surgical site infection (SSI) due to in a potentially-contaminated procedure?

A

Endogenous bacteria

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5
Q

Def contaminated operative procedure

A

Contamination present at surgical site, without obvious infection

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6
Q

SSI risk contaminated operative procedure

A

From endogenous bacteria

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7
Q

Def dirty operative procedure

A

Surgery performed where active infection is already present

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8
Q

SSI risk dirty operative procedure

A

Established pathogens

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9
Q

What is a rigid proctoscopy

A

Endoscopic examination of the anal canal using a proctoscope (direct vision)

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10
Q

What is a rigid sigmoidoscopy

A

Endoscopic exam of the rectum to recto-sigmoid junction using a rigid sigmoidoscope

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11
Q

Indications rigid scope (5)

A 
Suspicion colon neoplasia 
Ix IBD
Biopsies under direct vision 
Tx haemorrhoids 
Prior to op
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12
Q

What is a flexible sigmoidoscopy

A

Endoscopic exam visualising up to splenic flexure

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13
Q

Indications flexible sigmoidoscopy (5)

A 
CRC screening 
Surveillance prev diagnosed malignancy 
Endoluminal stent insertion - strictures 
Pre-op assessment - ano-rectal surgery 
Haematochezia req haemostasis
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14
Q

Indications tube thoracostomy (chest drain) (3)

A

Pneumothorax
Pleural effusion
Post op

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15
Q

Technique chst drain

A

LA into skin
2cm incision in triangle of safety
Blunt dissect into parietal pleura + palpate lung
Insert drain + attach to underwater seal
Apply airtight dressing + sit pt up to 45’
Chest position w/ CXR

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16
Q

Where is the ‘triangle of safety’ for chest drain

A

Betw lateral border of pec major + lat dorsi, sup to 5th ICS , inf to axillary border

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17
Q

What does an ileostomy look like

A

Spouted
On RHS
Bilious contents

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18
Q

What does 1 visible lumen indicate - ileostomy

A

= end ileostomy

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19
Q

When is an end ileostomy used

A

After removal of distal bowel
(permenant)
UC

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20
Q

What does 2 visible lumens indicate - ileostomy

A

Loop ileostomy

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21
Q

Indications look ileostomy (3)

A

Rest distal bowel (IBD)
Temporarily protect distal anastomoses following surgery
Provide functional relief from severe incontinence
TEMPORARY

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22
Q

Features of colostomy (3)

A

Flush to the skin w/ flat mucosal folds
LHS
> faeculant

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23
Q

What kind of op’s are end colostomies used after (3)

A

Hartmanns
Left hemicolectomy
AP resection

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24
Q

When are urostomies used?

A

After radical urinary tract surgery

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25
DDx urostomy
End ileostomy
26
What is a gastrostomy
Connection for ant stomach to ant abdo wall
27
When are gastrostomies used?
For stomach drainage or direct feeding
28
Features gastrostomy (4)
Narrow Flush to skin LUQ Fitted w/ indwelling access devices
29
What is a Jejunostomy
Connection from jejunum to ant abdo wall
30
When are jejunostomies used
Feeding
31
Early complications of stoma (3)
Infarction/necrosis Infection High output --> severe dehydration
32
Late complications stoma (4)
Parastomal hernia - incisional hernia @ stoma site Stoma prolapse Stoma retraction Stenosis
33
Practice examination of a stoma
Do it
34
Indications - urethral catheterisation (4)
Urinary retention Output monitoring Incontinence Surgery
35
C/I urethral catheter (2)
Urethral injury | Acute prostatitis
36
Size of catheter - M
14
37
Size of catheter -- F
12
38
When should the catheter bag be emptied?
When 2/3 full
39
Who needs suprapubic catheter (2)
Pelvic trauma | Suspected urethral injury
40
Complications - catheteristion (6)
``` Retrograde infection Paraphimosis Creation false passages Urethral stricutres Urethral perforation Bleeding ```
41
How to take specimen from catheter
Aseptically from port in tubing | Or aseptic aspiration of tubing
42
Active drains
Inv suction forces provided by vacuumed containers + = used to draw out collections
43
Passive drains
Function by differential P between body + exterior ie gravity
44
Are open drains passive or active
Passive
45
What are closed drains
Tube systems that drain directly into a container w/ orw/o suction
46
Indications - drain placement (3)
Remove abnorm collections fl/blood/pus/air Prevent build up of bodily fl/air Warn of potentially serious complications
47
How long after peri-op bleed do you remove drain
48h
48
Complications of drains (4)
Damage to structure during insertion Damage due to P effects on drain Infection Failure of drain
49
Indications - central venous catheter (6)
``` Critically ill pt req continuous CVP monitor Infusion of irritant substance Precise infusion for v NTW LT access - nutrition, chemo, ABx Haemodialysis If no other vv access available ```
50
Types of central vv catheter (3)
Hickmann PICC line Portacath
51
Hickmann placing
beneath skin | At IJV on right
52
PICC line placing
Inserted in arm and advanced to SVC
53
COmplications central vv catheter (6)
``` Haemorrhage pneumothorax Thoracic duct damage Air embolism Thrombosis Catheter related sepsis ```
54
Where does Swan Ganz catheter go
From femoral vv --> RHS heart into pulm aa
55
Function Swan Ganz catheter
measure pulm aa P
56
Indications Swan Ganz catheter (4)
Assess haemodynamic response therapies Monitor complicated MI/post cardiac surg Diagnosis pulm oedema Diagnosis PE/idiopathic pulm HTN
57
Complications Swan-Ganz catheter (3)
Arrythmias Valve trauma Pulm aa rupture
58
Indications arterial catheter (2)
Freq ABG | Continuous invasive BP monitoring
59
Allen's test
Elevate hand Ask pt to make fist + occlude uln + radial aa 30s Pt open hand - blanched Release ulnar aa --> colour returns in 7s
60
Complications art line (3)
Digital ischaemia Thrombosis Haemorrhage
61
What are the 4 stages of wound repair
Haemostasis (immediate) Inflammation (0-3 days) Proliferation (3days-3w) Remodelling (3w to 1y)
62
Haemostasis
Platelet aggregates at site Release inflamm markers + activate clotting cascade Vasospasm + thrombus formation
63
Inflammation
VD + incr cap perm --> oedema Neutrophils debride + kill bacteria Macrophages phagocytose debril --> fibroblast migration
64
Proliferation
Fibroblasts synth collage myofibroblasts secrete actin cont products --> would contraction Angiogenesis stim'd --> granulation tissue
65
Remodeeling
Re-orientation + maturation collagen fibres inc wound strength
66
When does 1' intention healing take place?
Where there == a lccosed appositon of clean wound endges
67
When does 2' intention healing take place
Where skin edges cannot be clearly opposed
68
Factors affecting wound healing (6)
``` DM Nutrition Smoking HGH levels Infection RA (inflamm conditions) ```
69
When can 'tidy' wounds be closed?
<12hrs | --> minimal skin loss
70
Mx of 'untidy' wound closure
Wound excision w/ removal of debris/dead tissue
71
When is delayed closure of a wound indicated?
If >6hrs old | Or heavily contaminated
72
Mx of delayed wound closure
Dress and inspect daily for further necrosis/inflamm | Then will be closed at 48-72h if ok q
73
Inflammatory changes in a wound/around a suture (5)
``` Calor Rubor TUmour Dolor Dunction laesa ```
74
Mx options infected surgical wound
IV ABx Re-intervention either ward, or threatre Open, drain, debride, rinse, pack wound CULTURE

CP3 SURGERY (19 decks)

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